Module #5: Clinical and Situational Factors

Contents

5.1 Introduction
5.2 Overlap of Events
5.3 Use of Emergency Room, Crisis Intervention or Detox Units
5.4 Psychiatric Inpatient Stays
5.5 Chapter 51 Emergency Detentions
5.6 Physical Aggression
5.7 Physical aggression has resulted in the injured person being hospitalized
5.8 Involvement with the corrections system
5.9 Suicide attempts

5.1 Introduction

Check all that apply or have applied within the specified timeframes.

Most items separate frequency "within the past year" from frequency "13 months to 3 years ago." This requires screeners to ask two separate frequency questions for each item:

• How often in the past year?
  and
• How often 13 months to 3 years ago? or How often in the two years before this past year?

This adds a little extra thought and time to the screening process. The benefits are that it allows greater recognition of serious problems that occurred more than a year ago, as well as frequent problems in the past year. This recognizes the cyclical nature of mental illness and stability resulting from MH supports received, for example, in the past year, since you can indicate the frequency of problems in years prior to the past year. Both time frames can be important in determining need for on-going MH supports.

If the events have occurred both in the past year and before then, indicate the frequency of events in both of the time periods.

It might be challenging for some applicants to answer these frequency questions. Screeners may need to consult written records or speak with other people (with the applicant's permission, of course) in order to determine the frequency of these items. If no such resources are available to you (e.g., with someone who just moved to Wisconsin), complete the functional screen as best as you can with the information you can obtain. In many cases, the applicant might make eligibility even with incomplete information. You can always update the functional screen as new information becomes available. If the applicant does not make eligibility due to insufficient background information, discuss it with your Screen Leader, who will call or e-mail designated state staff.

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5.2 Overlap of Events

One event could involve several items in this list. For instance, the person might have been suicidal, gotten drunk, assaulted someone, been arrested for OWI, been injured and treated in the ER, and had an emergency detention all in one evening. Alternatively, these all could have occurred as separate incidents. It doesn't matter; screeners can check all that apply in each timeframe.

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5.3 Use of Emergency Room, Crisis Intervention or Detox Units

• Use of emergency rooms can be for any reason, psychiatric or medical.
• The "Use of an emergency room" does not include going through the ER due to an emergency detention.
• Crisis intervention does not include telephone-only contact. Hospital Diversion should be counted as crisis intervention.

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5.4 Psychiatric Inpatient Stays

Any stay in a psychiatric hospital or psych unit of a hospital, voluntary or involuntary.

• If person was admitted over one year ago and is still there, check both "Within the past year" and "13 months to 3 years ago".
• If that same admission followed a Chapter 51 Emergency Detention (ED), you would check Chapter 51 ED "13 months to 3 years ago" and Psych inpatient stay "Within past year" and "13 months to 3 years ago."

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5.5 Chapter 51 Emergency Detentions

Wisconsin statute 51 allows for involuntary "emergency detention" if an individual presents immediate danger to self or others. Police do an "emergency detention" and 72-hour hold, which is followed by a probable cause hearing with a judge. You will check this box for any ED, regardless of the judges' decision, including if the judge dismisses it.

An "on-going ED" that's been extended several times is not really an ED anymore; it is "court orders" which you indicate elsewhere on the functional screen.

We are aware that the use of emergency detentions varies among counties, and may reflect local resources and the philosophies of the police, sheriff, and mental health systems as much as individuals' needs. The functional screen will provide data that stakeholders can analyze for local and statewide quality improvement in this area.

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5.6 Physical Aggression

Note: Verbal aggression is not included here. If verbal aggression is a serious problem, it is likely to show up elsewhere in the MH/AODA FS, for example, in problems with housing, social interactions, or managing symptoms.

Torturing or killing animals can be counted here only if it reflects abnormal psychoses, delusions, rage, or punishment of others (such as killing a child's pet to punish the child). While some people consider raising and killing farm animals to be "torture" and "abuse," for the MH/AODA FS screeners should restrict themselves to this more narrow use.

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5.7 Physical aggression has resulted in the injured person being hospitalized

Does not include ER visit only. This question reflects the reality that serious harm to others may have occurred several years ago but still be an important consideration for MH program eligibility. Check this box if the injured person was hospitalized or was killed.

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5.8 Involvement with the corrections system

This includes OWI/DUI, arrests, jail, prison, probation, parole, conditional release, Huber, bail monitoring, diversion agreement, etc. It does not include other interactions with police. It does not include minor traffic tickets, but does include driving under the influence or operating while intoxicated. The involvement is the applicant's own, not a family member's. If a person is arrested and then jailed for the same incident this should count as one event.

Jail is one continuous event and should just be captured when the event was initiated. For example, if a person was jailed 13 months to 3 years and the person was still in jail during the past year, this is one event and should only be captured in the "13 months to 3 years ago" time period. This is the case for the corrections question only because being jailed is for a relatively fixed period of time and is not reevaluated and extended based on the person's functioning. If the person was jailed two years ago and released and then jailed again in the past year for a separate crime or a parole/probation violation then both separate instances should be counted, one occurred "13 months to 3 years ago" and one occurred "within the past year."

In contrast, you will notice that the instructions state that for a psychiatric inpatient stay if the person was admitted over one year ago and is still there, check both "Within the past year" and "13 months to 3 years ago". This is because the continuation of a hospitalization is due to the ongoing severity of functioning of the person not the sentence being served for an original incident.

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5.9 Suicide attempts

A suicide attempt is an act with a significant risk of death. The judgment that a suicide attempt was "only a gesture," or was "just for attention" or "just manipulation" is excessively subjective. (It is also dangerous, because many suicides are preceded by multiple suicide attempts.)

Screeners should avoid subjective judgments about the individual's motivation or desired outcomes of the act. Instead, screeners should consider the level of risk of dying. For example, shallow cutting of the skin on the forearms is not a suicide attempt, as no blood vessels are cut to create risk of death. (Such cutting is indicated elsewhere in the MH/AODA FS, in "self-injurious behaviors.") However, large overdoses of pills or other acts with high risk of death are "suicide attempts," no matter how often they have occurred.

Has had a suicidal ideation with a feasible plan within the past two months
This item is intended to indicate people who are currently or recently struggling with suicidality.

Check this for applicant who:

• Currently feels suicidal and has a plan and the means to carry it out.
• Was close to suicide (with a plan and means) within the past two months, but does not feel that way today.

Do NOT check this for applicant who:*

• Says they are going to drown themselves in the lake, but is unable to walk or wheel outside of the house.
• Says "I just want to die," but does not have a plan and is not actively suicidal.

*Note: For these applicants, you still care about what they're saying, and follow up appropriately; you just don't check this box on the functional screen.

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